The Alliance Supports Legislation to Fix Hospice Special Focus Program

For Immediate Release
November 06, 2024

(Alexandria, VA and Washington, DC) –The National Alliance for Care at Home (the Alliance) has endorsed H.R. 10097, the Enhancing Hospice Oversight and Transparency Act, introduced in the House of Representatives. The Alliance supports delaying the implementation of the Centers for Medicare & Medicaid Service’s (CMS) hospice Special Focus Program (SFP), to allow for additional time to correct its flawed design that creates a high risk of failing to identify poor performing hospices that should be subject to increased oversight.

The SFP was created under the HOSPICE Act which established additional tools for CMS to oversee the Medicare Hospice Benefit. Notably, Representative Panetta —the original architect of the bill—has teamed up with Representative Van Duyne to decisively address and correct CMS’ flawed implementation of the program, ensuring it fulfills its original intent.

Research conducted by McDermott+ (M+) has detected significant concerns with CMS’ SFP methodology intended to identify poor performing hospices, particularly its dependence on incomplete survey data. SFP is intended to allow targeting of these providers for more frequent quality of care reviews. The report emphasizes that “the high rate of hospices not being timely surveyed reduces confidence that the SFP will accurately identify the lowest performers, allowing some poor performers to fly under the radar.” The M+ analysis further reveals that not surveying all hospices within the 36-month timeframe required by law leaves nearly 30% of hospices in their sample without a fully accurate performance assessment, underscoring the importance of timely evaluations to maintain accountability and support quality care. Additionally, some choices CMS made in designing the evaluation model were deemed “not methodologically sound,” raising further questions about its effectiveness.

In response to these findings, the Enhancing Hospice Oversight and Transparency Act seeks to adjust the start date of the SFP to January 1, 2027, allowing additional time to ensure compliance with the HOSPICE Act – the bill which created the hospice Special Focus Program –and revise critical flaws in its methodology, intended to identify poor performing hospices. This postponement will further ensure that surveys are completed for all hospice programs, a key step needed to evaluate performance.

“Ensuring the highest quality of care for hospice patients is essential. Medicare beneficiaries and their families deserve clear and accurate information to make informed choices,” said Dr. Steve Landers, CEO for the Alliance. “The Alliance supports the Enhancing Hospice Oversight and Transparency Act, a bipartisan initiative to pause the flawed SFP program and allow for necessary redesign through meaningful collaboration between CMS, Congress, and key stakeholders. By working together, we can build an oversight system that ensures quality care and guides families toward high-performing hospices, while holding accountable any providers unwilling or unable to meet these standards.”

The National Coalition for Hospice and Palliative Care joins the Alliance on behalf of the hospice community to call on Congress and CMS to continue these essential collaborative efforts with stakeholders to fix the SFP so that it accurately identifies the poorest-performing providers, ensuring all hospice patients receive high-quality care.

“The Coalition is committed to program integrity and high-quality hospice care nationwide,” said Jessica Hausauer, PhD, Executive Director of the National Coalition for Hospice and Palliative Care. “While we have collaborated closely with CMS over the years to support shared goals, the current design of the Hospice Special Focus Program raises significant concerns. We thank Representatives Van Duyne and Panetta for their leadership on this bill and urge CMS to delay the rollout, allowing for further input to ensure consumers receive accurate, reliable information in their search for quality care.”

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About the National Alliance for Care at Home
The National Alliance for Care at Home (the Alliance) is a new national organization representing providers of home care, home health, hospice, palliative care, and other health care services mainly delivered in the home. The Alliance brings together two organizations with nearly 90 years of combined experience: NAHC and NHPCO. NAHC and NHPCO are in the process of combining operations to better serve members and lead into the future of care offered in the home. Learn more at www.AllianceForCareAtHome.org.

Press Contact
communications@allianceforcareathome.org

Elyssa Katz | 571-281-0220
Thomas Threlkeld | 202-547-7424

2024 NHPCO Facts and Figures Report Now Available

FOR IMMEDIATE RELEASE
September 10, 2024

 2022 Data Show First Increase in Hospice Utilization Rates Since COVID

(Alexandria, VA and Washington, DC) – The National Alliance for Care at Home (the Alliance) published the 2024 edition of National Hospice and Palliative Care Organization (NHPCO) Facts and Figures, an annual report on key data points related to the delivery of hospice care, including information on patient characteristics, location and level of care, Medicare hospice spending, and hospice providers. Facts and Figures – the leading resource for hospice providers and others interested in understanding the work of the community – has been published annually for over two decades by NHPCO. NHPCO is currently integrating into the Alliance, a newly-formed national organization that is combining the two leading organizations supporting the care-at-home community – NHPCO and the National Association for Home Care & Hospice (NAHC).

The findings in this report reflect patients who received care in Calendar Year (CY) 2022, or Fiscal Year (FY) 2022, provided by hospices certified by the Centers for Medicare and Medicaid Services (CMS) and reimbursed under the Medicare Hospice Benefit. This year COVID-19 continued to impact patient care as COVID-19 waivers were still in place through May 2023. These waivers included increased telehealth services. With 49.1% of all Medicare decedents in 2022 choosing hospice care, utilization of hospice increased in 2022 for the first time since 2019. The increase hints at a normalization of the utilization rates back to pre-COVID data. Hospice utilization rates increased across all race and ethnicity groups, with the largest increase among Hispanic Medicare beneficiaries seeing. The total number of beneficiaries enrolled in hospice care in 2022 was 1.72 million. Due to the unique impact of COVID-19 on 2020 data, those data are not included in many of the charts this year.

“The hospice Facts and Figures has been an important and impactful NHPCO publication. It is a great example of the type of data and high-quality information the newly formed National Alliance for Care at Home plans to provide the hospice and broader care-at-home community for years to come,” said Dr. Steve Landers, Chief Executive Officer for the Alliance.

Select findings from this year’s report include the following:

      • 1.72 million Medicare beneficiaries were enrolled in hospice care for one day or more in calendar year (CY) 2022. This is a slight increase from 2021 but approximately equal to 2020.
      • Of all Medicare decedents in CY 2022, 49.1% received one day or more of hospice care and were enrolled in hospice at the time of death. This is the first increase in utilization since 2019.
      • In CY 2022, Medicare Advantage (MA) continued growing into a larger portion of the Medicare population. A vast majority of MA beneficiaries shift to Traditional Medicare to utilize the Medicare Hospice Benefit. A small sect of beneficiaries who stay with MA for hospice care have value-based insurance design (VBID) plans.
      • In CY 2022, 51.6% of White Medicare decedents used the Medicare Hospice Benefit. 38.1% of Asian American Medicare decedents and 37.4% of Black Medicare decedents enrolled in hospice. 38.3% of Hispanic and 37.1% of North American Native Medicare decedents used hospice in 2022. In CY 2022, there was an increase in hospice utilizations by all race/ethnicity groups, with the largest increase among Hispanic beneficiaries. No group has returned to pre-COVID-19 utilization percentages.
      • The principal hospice diagnosis is the diagnosis, based on ICD-10 codes, determined to be the most contributory to the patient’s terminal prognosis. Alzheimer’s/nervous system disorders/organic psychosis, at 25%, is the top category of diagnosis for hospice beneficiaries and appears multiple times in the top diagnoses by, ICD-10 code. Cancer and circulatory diseases round out the top three diagnoses groups which account for nearly three-fourths of all hospice beneficiary diagnoses.
      • Medicare paid hospice providers a total of $23.7 billion dollars for care provided in CY 2022, representing an increase of 2.7% over the previous year. This is slower growth compared to 2019-2021 but similar growth from 2020-2021.
      • In the most recently available data, 50.0% of participating providers received four or five stars on the CAHPS® (Consumer Assessment of Healthcare Providers and Systems) survey, which represents a 1% increase over the prior reporting period. However, Star Ratings were available for fewer than half of providers (2,046).

The 2024 Facts and Figures report is available to all on the NHPCO and Alliance websites.

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About NHPCO
The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we advance public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. NHPCO is currently in the process of joining with the National Association for Home Care & Hospice (NAHC) to form the National Alliance for Care at Home.

About the National Alliance for Care at Home
The National Alliance for Care at Home (the Alliance) is a new national organization representing providers of home care, home health, hospice, palliative care, and other health care services mainly delivered in the home. The Alliance brings together two organizations with nearly 90 years of combined experience: NAHC and NHPCO. NAHC and NHPCO are in the process of combining operations to better serve members and lead into the future of care offered in the home. Learn more at www.AllianceForCareAtHome.org.

Press Contact
Elyssa Katz
ekatz@nhpco.org  |  571-281-0220

Congressional Briefing Demonstrates the Value of the Medicare Hospice Benefit

For Immediate Release
July 28, 2023

New Research Shows Hospice Produces Better Outcomes, Lower Medicare Costs

(Washington, D.C. and Alexandria, VA) – On Thursday, July 27 a panel of healthcare experts presented groundbreaking new research at a Capitol Hill briefing for Congressional offices, showing that patient use of hospice contributed to $3.5 billion in Medicare savings in 2019, while also providing multiple benefits to patients, families, and caregivers.

The study, conducted by NORC at the University of Chicago, is one of the most comprehensive analyses of enrollment and administrative claims data for Medicare patients covered by Medicare Advantage and Traditional Medicare. The study was funded by the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO).

Panelists Dianne Munevar, VP of Health Care Strategy at NORC; Dr. Joseph Shega, Chief Medical Office at Vitas; and Susan Lloyd, CEO of Delaware Hospice, related their vast experience with hospice care, extolling its benefit for patients and their loved ones, and also shared findings which prove that longer hospice stays equate to greater savings for taxpayers and overall, better experiences for patients.

Susan Lloyd, CEO of Delaware Hospice shared her personal experience with her mother’s end of life care. “The full benefits of hospice care are realized when the patient and family have the opportunity to engage with the team who provides the support needed wherever [the patient] calls home. Hospice is not a place, it’s a way of caring for people and their loved ones as they are nearing the end of life,” said Lloyd. “One of the greatest blessings of my life was to be there when my mom died. She was not alone; she was surrounded by love. Hospice made that happen for mom, for me, and my family.”

“There’s a lot of myths and misperceptions about what hospice is and what hospice does because of short stays,” said Dr. Joseph Shega, Chief Medical Officer of VITAS. “So when you have a short stay, the hospice does incredible work to try to meet [patients] where they are to honor their wishes […] but if somebody would have that conversation four, five, six, months earlier, they could have an experience like what Jimmy Carter is experiencing now, where he’s chosen he wants to be at home and there’s no difference in life expectancy between those who enroll in hospice earlier vs. those who don’t. With hospice, you can provide that care at home.”

Key findings from the Value of Hospice study include the following:

      • NORC estimates that Medicare spending for those who received hospice care was $3.5 billion less than it would have been had they not received hospice care.
      • In the last year of life, the total costs of care to Medicare for beneficiaries who used hospice was 3.1 percent lower than for beneficiaries who did not use hospice.
      • Hospice is associated with lower Medicare end-of-life expenditures when hospice lengths of stay are 11 days or longer. In other words, earlier enrollment in hospice reduces Medicare spending even further.
      • Hospice stays of six months or more result savings for Medicare. For those who spent at least six months in hospice in the last year of their lives, spending was on average 11 percent lower than the adjusted spending of beneficiaries who did not use hospice.
      • At any length of stay, hospice care benefits patients, family members, and caregivers, including increased satisfaction and quality of life, improved pain control, reduced physical and emotional distress, and reduced prolonged grief and other emotional distress.
(Source: NORC at the University of Chicago)

“The longer the hospice stay, the more the potential savings,” said Dianne Munevar, Vice President of Health Care Strategy at NORC. “Even when hospice care is 89 percent of total cost, spending is still 12 percent lower compared to the non-hospice [patient]. That’s a huge difference and a huge value to Medicare.” Even when hospice stays exceed six months, Medicare still saves money. “The longer the stay across all disease groups…hospice spending was 11 percent lower than the non-hospice users,” explained Munevar.

A recording of the briefing is available.

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About NAHC
The National Association for Home Care & Hospice (NAHC) is the voice of home care and hospice. NAHC represents the nation’s 33,000 home care and hospice providers, along with the more than two million nurses, therapists, and aides they employ. These caregivers provide vital services to Americans who are aged, disabled, and ill. Some 12 million patients depend on home care and hospice providers, who depend on NAHC for the best in advocacy, education, and information. NAHC is a nonprofit organization that helps its members maintain the highest standards of care. To learn more, visit nahc.org.

About NHPCO
The National Hospice and Palliative Care Organization (NHPCO) is the nation’s largest and oldest membership association for providers who care for people affected by serious and life-limiting illness. Our members deliver and expand access to high-quality, person-centered interdisciplinary care to millions of Americans. NHPCO provides education and resources to support that mission. Together with our advocacy partner, the Hospice Action Network (HAN), we serve as the leading voice advancing public policy to improve serious-illness and end-of-life care, while our CaringInfo program provides free resources to educate and empower patients and caregivers. nhpco.org

New Resource to Support Outreach to Chinese American Communities

For Immediate Release
May 25, 2022

NHPCO Provides New Resource to Support Outreach to Chinese American Communities

NHPCO’s Diversity Advisory Council Developed New Guide to
Improve Equity and Increase Access to Hospice and Palliative Care

(Alexandria, Va) – The National Hospice and Palliative Care Organization (NHPCO) today released a new Chinese American Resource Guide to support hospice and palliative care providers’ work to deepen connections with Chinese American communities as part of the effort to improve equitable access to serious-illness and end-of-life care. The new guide was developed by NHPCO’s Diversity Advisory Council in partnership with the Chinese American Coalition for Compassionate Care (CACCC). Published as part of Asian American and Native Hawaiian/Pacific Islander Heritage Month 2022, the guide builds on and replaces a previous resource, and is part of a body of NHPCO resources on diversity, equity, and inclusion.

NHPCO President & CEO, Edo Banach, said, “To improve access to hospice and palliative care, providers must connect with different populations in their communities, build relationships, and deepen understanding about the care they provide. The data show that the number of people choosing hospice care has grown for twenty years. Yet, the uptake amongst white Medicare beneficiaries remains higher than among their Asian, Black, Hispanic, or Native Americans peers. To get to equitable access, providers need to focus on making connections with these communities. The Chinese American Resource Guide is one tool in a suite of resources developed by our Diversity Advisory Council for this purpose. This effort is so important that we making these resources available to both NHPCO members and non-members on our website.”

Research shows that Chinese Americans often have low levels of familiarity with hospice and would like to learn more. This guide can help providers bridge that gap. Topics covered in the guide include an overview of Chinese American cultural beliefs, resources for community engagement, a glossary with English to Chinese translations of terms related to hospice and palliative care, and outreach strategies to increase access and quality of care for aging and critically ill Chinese Americans.

“NHPCO’s Chinese American Resource Guide examines the importance of partnerships to advance best practices in community engagement, Advance Care Planning, training and utilizing volunteers, and developing culture-specific end-of-life resources,” said Sandy Chen Stokes, founder of CACCC and member of NHPCO’s Diversity Advisory Council. “The Guide benefits from knowledge gained through collaborations with local, state, and national end-of-life experts who understand the importance of cultural and ethnic considerations in end-of-life decision-making.”

The Chinese American Resource Guide is available for download at nhpco.org/diversity, the page that serves as a hub for NHPCO’s diversity, equity, and inclusion resources, including the overarching resource, titled the Inclusion and Access Toolkit, and the Spanish-language version of the toolkit, Descargar Kit de Herramientas de Inclusión y Acceso, as well as the Black and African American Outreach Guide, the Latino Outreach Guide, and the LGBTQ+ Resource Guide. Users whose organizations are not members of NHPCO will have to provide their contact information in order to access each resource. Members can access these resources by simply logging into the site.

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Contact:
Caleb Tiller
ctiller@nhpco.org
Ph: 571-412-4032

NHPCO Welcomes Curitec as New Strategic Partner

For Immediate Release:
April 12, 2021

Curitec is a Diamond Level Strategic Partner and Gold Level Sponsor of Quality Connections

(Alexandria, Va) – The National Hospice and Palliative Care Organization (NHPCO) is proud to welcome Curitec as a Diamond Level Strategic Partner. Through this partnership, Curitec will play a valuable role in support of NHPCO’s efforts to lead person- and family-centered care in the U.S.

Additionally, to demonstrate Curitec’s commitment to continuous quality improvement in the hospice and palliative care provider community, they have stepped up as a Gold Level Sponsor of NHPCO’s new Quality Connections program. Quality Connections was developed and launched in January 2021 to enhances the knowledge base, skills, and competency of hospice and palliative care staff through education, tools, resources, and opportunities for engagement and interaction among hospice and palliative care professionals.

“Through its generous support, Curitec is joining NHPCO in working on behalf of hospice and palliative care providers and professionals with a focus on innovation, access, and quality,” said NHPCO President and CEO Edo Banach. “Ultimately, support of our mission and the membership is all about ensuring the highest standard of care for patients and families, and excellence among the provider community.”

Curitec CEO Maria Percival stated, “We are excited to be a strategic partner of NHPCO and are looking forward to the opportunity to work alongside this wonderful organization and its members, to provide valuable insight on how our hospice communities can utilize our Medicare Part B services to provide advanced wound care supplies to treat and heal wounds on hospice patients who qualify for this service, as part of their benefits.”

Curitec’s mission is to help enhance the quality of care through the use of consistent and high-quality wound care products, innovative technology, and robust educational resources to support long-term care and hospice communities. Curitec provides service in all 50 states and is committed to providing its customers with robust educational resources designed to deliver an enhanced high-quality, experience to both patients and health care professionals.

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Contact:
Jon Radulovic
NHPCO Communications
Ph: 571-412-3973

MedPAC Votes to Modify Hospice Aggregate Cap

For Immediate Release:
January 14, 2021

MedPAC Votes in Favor of Modifications to the Hospice Aggregate Cap

NHPCO concerned about unintended consequences to access and quality

(Alexandria, Va) – The National Hospice and Palliative Care Organization (NHPCO) was present at today’s virtual public meeting when the Medicare Payment Advisory Commission (MedPAC) voted on recommendations that were introduced at the December 2020 public meeting. Commissioners voted unanimously in favor of eliminating the update to the fiscal year 2021 Medicare base payment rates for hospice for fiscal year 2022 and to wage adjust and reduce the hospice aggregate cap by 20 percent.

NHPCO firmly believes that the recommended modifications to the hospice aggregate cap will negatively impact access to care and potentially drive people to more expensive care settings. NHPCO is especially concerned for people living in rural and underserved areas, as hospice providers have noted that these dramatic cuts could result in unintended hospice closures, particularly in low wage index and underserved areas.

“NHPCO does not support MedPAC’s recommendation to modify the hospice aggregate cap because this approach is overly broad and careless, especially in light of the strain put on providers by the COVID-19 pandemic. If the recommendation is adopted by Congress, it could lead to a decrease in hospice access for patients and families, especially in rural and underserved areas. In the short term, we urge MedPAC to use a targeted approach that will have a higher likelihood of rewarding high quality and improving access,” said NHPCO President and CEO Edo Banach.

“MedPAC’s role is very important but I have serious reservations with the recommendation to cut the hospice program in the midst of a global pandemic.  It is unsafe and potentially harmful to our most vulnerable citizens. Given the unprecedented challenges hospice organizations are already facing while providing care to individuals in the safety of their own home, the policy recommendations could ultimately limit access to high-quality hospice and palliative care services. I would hope for the sake of seriously ill Kentuckians that MedPAC instead focus on minimizing the hardship hospice organizations are experiencing during this incredibly difficult time to ensure that our most vulnerable will have access to the care they deserve. The sweeping recommendations lack nuance and could have very real consequences that limit the ability of hospice organizations to effectively respond to the needs of dying Medicare beneficiaries,” said Liz Fowler, CEO of Kentucky-based hospice provider Bluegrass Care Navigators.

“We urge MedPAC to reconsider recommendations that cut the hospice program. The last year has shown how important high-quality hospice and palliative care services are to vulnerable patients and their families, and we would not want to do anything that would limit access. For the sake of New Yorkers in need of these critical services during this time of unprecedented challenges, we encourage MedPAC to share their insights into ensuring access to the care New Yorkers deserve,” said Rosemary Baughn, Senior Vice President of Visiting Nurse Service of New York Hospice and Palliative Care.

“We do not support MedPAC’s recommendation to wage index and reduce the hospice aggregate cap by 20 percent. Absent reliable data and analysis, it is unclear how such reductions would lead to Medicare savings, increase access to care, or lead to higher quality of care for Californians,” said Cortland Young, Chief Clinical Officer, Central Coast VNA and Hospice.

“We strongly urge MedPAC to reassess their recommendations that make unnecessary cuts to the hospice program. Floridians are in need of these critical hospice services and additional cuts will only compound a host of issues the community is already struggling with, including reimbursement issues related to increased PPE costs and increased staffing costs. Cutting reimbursement at this difficult time would present even more challenges to the hospice community,” said Samira Beckwith, President and CEO of Hope Healthcare.

NHPCO will continue its dialog with MedPAC and is ready to offer assistance to MedPAC to determine current savings to the system when hospice is chosen as an alternative to costlier services, as this analysis is necessary in informing any proposals to change the hospice reimbursement rate or the aggregate cap.

Providers should remember that MedPAC is an advisory body that makes recommendations to Congress. Even with a unanimous vote in favor of the modifications to the hospice aggregate cap, Congress must adopt the necessary legislative changes to put these recommendations into effect. For more detailed information on the recommendations, NHPCO members should see the 12/03/20 Policy Alert on the Regulatory Alerts and Updates page of the NHPCO website.

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Contact:
Jon Radulovic
Communications Team
Ph: 571-412-3973

Learn more about hospice on NHPCO’s CaringInfo.org